As nurses, we know that it is common for one of us to go the extra mile in caring for a patient. It is so common in fact that we often don’t even notice when it happens. However to each patient and family on the receiving end of such care, it is extraordinary. An unsolicited letter from Jan, a woman who wanted to share her appreciation and gratefulness for the above-and-beyond care a psychiatric nurse gave her family member, was delivered to APNA recently. APNA member Valerie Kolbert, ARNP, BC made an enormous difference in this patient’s life and in that of the patient’s family member by providing psychiatric-mental health nursing care that she saw as normal. “When you work hard every day doing your best and what you think is the right thing, it becomes ordinary,” she says. “When I read Jan’s letter, it reminded me that what we do as nurses IS pretty extraordinary.”

Jan’s letter describes the care Valerie delivered to Jan’s cousin, Mary, a woman who had sustained a brain injury in addition to having three metastic brain tumors, and diagnoses of bipolar and stage 3 breast cancer. Jan writes, “Valerie was with her throughout the entire ordeal and without question Ms. Kolbert’s treatment not only extended Mary’s life, it helped her to address unresolved issues and made her more able to accept her terminal diagnosis.” She writes of how deftly “she handled difficult issues while moving Mary forward at a pace Mary could handle.” The care Valerie provided to her cousin Mary during a difficult time “is beyond any expectation one could ever have of a medical professional,” Jan writes.

Valerie explains the complications she and Mary were working with: “It was a constant guessing game as to what was causing which symptoms and what we should do about it. There were 4 separate physical assaults to her brain (3 brain tumors and the prior brain injury) with her bipolar diagnosis thrown in as the cherry on top.” She worked hard to coordinate care and communicate with Mary’s oncologist. “I tried to fill in the gaps for Mary and her cousin and thanked God I care for so many cancer patients so I could speak from experience,” she says. “Mary and I reframed a lot of her experience to see the humor in her situation and that helped her more than anything, the realization that there was no one right or wrong way to deal with death, she could handle her death however she wanted to and it was okay.”

When Jan, who lived 2,500 miles away, had not heard from Mary for several days, she called Valerie’s office to ask if they had heard from her. Then when Mary missed her appointment the next day, Valerie tried to reach her without success. She called Jan and volunteered to drive to Mary’s home, 25 minutes away. “Since I routinely make home visits I did not think it was any big deal to go check on Mary at home…I knew something had to be wrong for her to miss her appointment,” says Valerie. When no one answered the door at Mary’s home, the police were called. They broke into the house and found Mary on the floor, semi-conscious, where she had obviously been for days. “In most cases, after Mary was taken to the hospital by ambulance, the medical professional would think her job was done,” Jan writes. “Not Valerie. Knowing how important Mary’s dog and cat were to her, she took the cat (no small thing as this cat is a nightmare) and brought Mary’s dog to the hospital…knowing how much this would mean to her.” Valerie remembers, “Mary was grateful that I made sure that Maggie (her service dog) and Screwy were safe. She also split her sides laughing when I told her the escapades of Screwy when I brought her home and she met my dog Harley.”

Valerie rearranged long-standing travel plans with her daughter at the last minute so that she could check on Mary in the hospital. “Very few people would have made that decision,” writes Jan. Of her decision, Valerie says: “I do what I feel is appropriate in each case and Mary’s case called for some special handling. Because she was such a complicated case…I wanted to make sure the hospital had her correct history and meds. I knew if I went to Boston without checking her meds at the hospital, I would be worrying about her all weekend,” she continues. “I was the only person who knew her entire history and we had worked too long and too hard to get her meds just right.” She even stopped by the next morning before catching her flight. “She continued to see Mary while she was in the hospital and also when she moved to the rehab facility,” writes Jan. “Without question she always had Mary’s best interest at heart. Ms. Kolbert always treated her as if she was more than just a patient; she treated her with genuine concern and caring. I can say without reservation that the treatment my cousin received from Ms. Kolbert and her staff is exceptional. She made Mary’s life a better place to be and gave her comfort and optimism in facing the end of her life. We are all very fortunate Ms. Kolbert is such a talented professional.”

To Valerie, she wasn’t really “going the extra mile” in this instance -- it is how she would treat any patient. This is indicative of the mindset with which she approaches her role as a psychiatric-mental health nurse: “I always liked the nursing theory that said nurses do for others what they would do for themselves if they were able. It's not about you, it's about the patient,” she says. “If you would advocate for a family member, are our patients any less worthy? It's the same reason I would bring Mary back a box of Montilio's sugar cookies whenever I went to Massachusetts,” she says. Montilio is a family-owned bakery in the state - Mary used to date one of the Montilio boys and wanted very much to visit the town of Scituate again. “I knew she would never be able to go back north again so I would bring a bit of New England to her…this was such a small thing that brought her such happiness,” she says. “When I read Jan's letter I realized that she got it, that I really did care for her cousin and did for her what Jan would have done if she were able.”

In her treatment of Mary’s illness, Valerie epitomized the dedicated person-centered care that we all strive towards as PMH nurses. Jan’s letter shows the importance of connection and engagement, of partnership with families, and of a shared responsibility for the patient's safety in facilitating and supporting well-being through life's most challenging transitions. Valerie’s actions had a profound effect on Mary and her family and truly show her to be an exceptional nurse. She sets a wonderful example and it is great to see such a dedicated professional receive the recognition she deserves. “I have realized that sometimes knowledge comes from places other than textbooks,” she says. “Wisdom comes from experience and experience comes from lack of wisdom. I'm just glad that Mary's last few months were happy . That's where the satisfaction of a job well done comes in.”

*Names have been changed for privacy purposes.

Valerie Kolbert earned her BSN from the University of Pennsylvania in 1977 and her MS in Adult-Psych Community Mental Health Nursing from Columbia in 1984. She has worked as a psychiatric nurse for her entire career, in a variety of settings: inpatient, chronic care day programs, outpatient, psychiatric home health, and “even as a mental health coordinator for The Mothers Center where I taught Mommy and Me classes to get the moms in for group therapy!” She now has a private practice in Florida where she sees patients in the office 3 days a week and makes home visits two days a week, with a focus on geropsych. She is a past President of the APNA Florida Chapter.

The American Psychiatric Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

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